Simmons & Alonge Oral Surgery

Re: Claim: [redacted] Dear Sir/Madam, This letter is in response to a complaint submitted against Oral Surgery of ErieThe patient was seen December 7,for evaluation of third molars (wisdom teeth)The dispute centers on whether this was an "examination" or a "consultation", a differentiation which is solely made by insurance companies and governed by their rules and regulationsAlthough we are quite familiar in the correct way to bill for this I decided to verify as a favor to the patientThe billing department for the American Association of Oral & Maxillofacial Surgeons was contacted and the situation was described in detailThe billing expert for AAOMS confirmed that we were correct in billing for an examination and not a consultationThe claim that I never looked in the patient's mouth is completely fabricatedMy chart notes clearly document the findings of an intraoral examInsurance products can be complicated, difficult for the public to understand and at times arbitraryIf the wisdom teeth had been impacted, a medical examination code is indicated and more often is a covered benefitIn this case they were not impacted, therefore a dental claim is generated and the patient is subject to the "once every six months" limitationWe have no way of knowing in advance what the particular classification will beNothing inappropriate occurred hereThe patient merely received a bill and is unhappyI have no control over what a particular benefit plan chooses to coverI refuse to play games and alter codes to sidestep a patient's valid out of pocket expenseValuable staff time has been spent addressing this complaint and it is meritless Matthew *S [redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.Matthew S*** offered no resolution in this matterHe did not look into my mouth as he claims that he didAny notes in my chart, stating that he looked in my mouth are fabricatedHe viewed x-rays provided to him by my referring dentist and made me watch a videoI wish for him to accept the $already paid as payment in full and drop this matter.
Regards,
*** *** ***

Re: Claim: *** Dear Sir/Madam,
transparent;">This letter is in response to a complaint submitted against Oral Surgery of ErieThe patient was seen December 7,for evaluation of third molars (wisdom teeth)The dispute centers on whether this was an "examination" or a "consultation", a differentiation which is solely made by insurance companies and governed by their rules and regulationsAlthough we are quite familiar in the correct way to bill for this I decided to verify as a favor to the patientThe billing department for the American Association of Oral & Maxillofacial Surgeons was contacted and the situation was described in detailThe billing expert for AAOMS confirmed that we were correct in billing for an examination and not a consultationThe claim that I never looked in the patient's mouth is completely fabricatedMy chart notes clearly document the findings of an intraoral examInsurance products can be complicated, difficult for the public to understand and at times arbitraryIf the wisdom teeth had been impacted, a medical examination code is indicated and more often is a covered benefitIn this case they were not impacted, therefore a dental claim is generated and the patient is subject to the "once every six months" limitationWe have no way of knowing in advance what the particular classification will beNothing inappropriate occurred hereThe patient merely received a bill and is unhappyI have no control over what a particular benefit plan chooses to coverI refuse to play games and alter codes to sidestep a patient's valid out of pocket expenseValuable staff time has been spent addressing this complaint and it is meritless Matthew *S*** ***

Re: Claim: [redacted] Dear Sir/Madam, This letter is in response to a complaint submitted against Oral Surgery of Erie. The patient was seen December 7,2015 for evaluation of third molars (wisdom teeth). The dispute centers on whether this was an "examination" or a "consultation", a differentiation...

which is solely made by insurance companies and governed by their rules and regulations. Although we are quite familiar in the correct way to bill for this I decided to verify as a favor to the patient. The billing department for the American Association of Oral & Maxillofacial Surgeons was contacted and the situation was described in detail. The billing expert for AAOMS confirmed that we were correct in billing for an examination and not a consultation. The claim that I never looked in the patient's mouth is completely fabricated. My chart notes clearly document the findings of an intraoral exam. Insurance products can be complicated, difficult for the public to understand and at times arbitrary. If the wisdom teeth had been impacted, a medical examination code is indicated and more often is a covered benefit. In this case they were not impacted, therefore a dental claim is generated and the patient is subject to the "once every six months" limitation. We have no way of knowing in advance what the particular classification will be. Nothing inappropriate occurred here. The patient merely received a bill and is unhappy. I have no control over what a particular benefit plan chooses to cover. I refuse to play games and alter codes to sidestep a patient's valid out of pocket expense. Valuable staff time has been spent addressing this complaint and it is meritless.                                                                                                                                                                                                                                                                                                                                                                                                                         Matthew *. S[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Matthew S[redacted] offered no resolution in this matter. He did not look into my mouth as he claims that he did. Any notes in my chart, stating that he looked in my mouth are fabricated. He viewed x-rays provided to him by my referring dentist and made me watch a video. I wish for him to accept the $30.00 already paid as payment in full and drop this matter. 
Regards,
[redacted]

Review: I was referred to this company for the extrication of my 4 non impacted wisdom teeth. I went there for a consultation to verify information and get scheduled for surgery. They collected my $30.00 copay and sent me on my way to wait until they get the pre approval from my insurance provider. Later it came back that my consultation was not covered because they billed it as an examination. The provider did not look into my mouth. The provider looked at x-rays, verified the dentist's findings, that they needed to come out, and told me to schedule surgery. They refuse to call the dental insurance and find the correct billing code for consultation. Claiming they have been billing as an exam for 19+ years and if they change the code it's fraudulent. I was told by my insurance company I am covered for 2 exams (which the dentist does) and 2 consultations. I was also told that the company needs to call the Dentist association to get the correct billing code. I am unable to get the billing code because they will only speak with dentist/oral surgeon offices directly. Last week I spoke to them on the phone again and left a message for the doctor to call me back when he returned. He was to of returned Tuesday. It is Friday. I have no heard from them. They are attempting to collect $110.00 from me, threatening me with fees for non pay. The consultation service was provided in December of 2015.

I have called them multiple times requesting call backs after they were suppose to look into it for me. They have never called me back.

I just read the bill again. It's billed as a " Comprehensive oral evaluation " The first definition that came up for that in google is ""A comprehensive oral exam is an extensive evaluation and recording of all extra oral, intra oral, soft and hard tissues. A recare exam (check up) is an exam that is done on established patients to determine any changes in dental and health status since a previous comprehensive or periodic evaluation."" They NEVER looked into his mouth.Desired Settlement: I'd like for them to bill the appointment correctly so that it is a covered service or waive the rest of the bill.

Business

Response:

Re: Claim: [redacted] Dear Sir/Madam, This letter is in response to a complaint submitted against Oral Surgery of Erie. The patient was seen December 7,2015 for evaluation of third molars (wisdom teeth). The dispute centers on whether this was an "examination" or a "consultation", a differentiation which is solely made by insurance companies and governed by their rules and regulations. Although we are quite familiar in the correct way to bill for this I decided to verify as a favor to the patient. The billing department for the American Association of Oral & Maxillofacial Surgeons was contacted and the situation was described in detail. The billing expert for AAOMS confirmed that we were correct in billing for an examination and not a consultation. The claim that I never looked in the patient's mouth is completely fabricated. My chart notes clearly document the findings of an intraoral exam. Insurance products can be complicated, difficult for the public to understand and at times arbitrary. If the wisdom teeth had been impacted, a medical examination code is indicated and more often is a covered benefit. In this case they were not impacted, therefore a dental claim is generated and the patient is subject to the "once every six months" limitation. We have no way of knowing in advance what the particular classification will be. Nothing inappropriate occurred here. The patient merely received a bill and is unhappy. I have no control over what a particular benefit plan chooses to cover. I refuse to play games and alter codes to sidestep a patient's valid out of pocket expense. Valuable staff time has been spent addressing this complaint and it is meritless. Matthew *. S[redacted]

Consumer

Response: